Basic knowledge in critical care nursing is a body of knowledge beyond that required for licensure as an RN that the critical care nurse uses in order to provide safe nursing care to patients. Since safe practice is regarded as a moral and professional responsibility, basic knowledge is information that is necessary for entry into critical care nursing and represents the foundation for job performance.

A primary aim of in-service education in critical care nursing is to assure that staff nurses demonstrate an understanding of this basic knowledge. Because of on-going research studies (since 1979), publications, and the use of the BKAT over the past 31 years, it has become accepted as one standard for measuring basic knowledge in critical care nursing. To date, over 9,785 critical care nurse educators and nurse managers in the USA have requested and have received a copy of one of the BKATs to photocopy for use in their practice. Critical care nurses in over 24 different foreign countries have also requested and received a copy of one of the BKATs.

The BKAT-8SR

The most recent version of the adult Telemetry/Progressive Care BKAT is Version Eight R (2010). It is an 80 item paper and pencil test that measures basic knowledge. These items measure content related to the following areas of critical care nursing practice: cardiovascular, neurology, endocrine, renal, pulmonary, gastrointestinal/parenteral, and other. The category ‘other’ includes such areas as infection control, hypothermia, monitoring lines, and emotional/spiritual care. The 80 items are almost exclusively a subset of the 90 item BKAT-8 test for adult ICU.

The BKAT-8S R takes approximately 40 minutes to complete. The total possible score is 80 points. Items on the BKAT-8SR contain multiple choice and fill-in-the-blank questions that measure both the recall of basic information and the application of basic knowledge in practice situations. Psychosocial aspects of critical care nursing practice are integrated into specific questions in the BKAT-8S R.

Content for the initial version of the BKAT was identified through a review of the literature and interviews with staff nurses and head nurses working in critical care units, and through the suggestions from two critical care physicians and a nine member panel of experts in critical care nursing practice and education.

Validity for each of the eight versions of the BKAT was established through a panel of experts. Validity has also been supported through replication of research findings related to group differences, learning theory, and variables associated with (and not associated with) scores on the BKAT.

Construct validity. The construct, basic knowledge in Telemetry/Progressive Care, was measured in four groups of nurses using the BKAT-7S: USA RNs with > one year of experience, foreign-born nurses with < one year of experience in the USA, new graduate nurses from the USA, and senior USA baccalaureate (BSN) nursing students. An analysis of variance of scores on the previous BKAT-7S among these four groups was statistically significant, F (3,43) = 17.6, p < .001. Post hoc comparisons, using Scheffe, showed that the USA RNs with > one year of experience had higher scores than all other groups: Foreign-born nurses (p< .02, sign), the new graduates (p<.001, sign), and the BSN students (p. <.001). Not previously reported, there was no statistical difference between the foreign nurses and the new graduates (p=0.56, NS), and the foreign nurses and the BSN students (p = .87, NS). Since foreign-born nurses working in foreign countries, new USA graduates, and BSN USA students are known--by previous research findings by Toth (2003, 1984)--to score lower on the BKATs, the research findings in this study supported the construct validity of the previous version of the BKAT-7S.

Construct validity of the BKAT-8S R was measured during reliability testing through the technique of known group differences. RNs with > one year experience in nursing and working in Telemetry/Progressive Care (n=114) were compared using a t-test for independent groups to new graduate nurses (n=23), a group known to be different, with < one year experience in nursing, and working in Telemetry/Progressive Care. The results were statistically different with the experienced RNs scoring higher than the new graduate nurses: t (44.1) = 2.04, p < .025 [one tail], Sign.

Interestingly, additional support for the validity of the BKAT-8S R occurred when the two groups were found to have statistically different variance in their scores [F = 5.0, p = .027] or that Levene’s Test for Equality of Variances was not met for the t-test, or that the two groups may represent a different population of nurses. This same inequality was also found in previous research on the BKAT when baccalaureate nursing students were compared to RNs working in the intensive care unit.

Reliability and Average Scores

Reliability, history. Cronbach’s Coefficient Alpha (a) has been used as the measure of internal consistency for all previous versions of the BKAT. Reliability of the first version of the Telemetry/Progressive Care BKAT (BKAT-4S) was computed on a sample of 162 nurses working in Telemetry/Progressive care units from 10 states in the USA and was alpha=0.83. Reliability for the fifth version (BKAT-5S) was computed on a sample of 85 nurses working in Telemetry/Progressive Care from eight states in the USA and was alpha=0.82. Reliability for the seventh version (BKAT-7S) was 0.85.

Reliability testing of the BKAT-8S R. Reliability for this version, the BKAT-8S R, was measured using Cronbach’s coefficient alpha and is = 0.77. Reliability was computed on tests taken by 137 nurses working in Telemetry/Progressive Care from the following six states: Arizona, Massachusetts, Michigan, North Carolina, New York, and Ohio.

The average score. Scores on the BKAT-8S R ranged from 37 to 78 out of a possible 80 points. The average score on the BKAT-8S R for 114 RNs with > one year experience and working in Telemetry/Progressive Care was 63.2 (79.0% correct answers) and the standard deviation was 7.4 points.

No one is expected to achieve 100%. Rather, it is expected that following orientation, Telemetry/Progressive Care nurses will achieve an average score of 62 (77.5%) to 64 (80.0%) on the BKAT-8S R. Whether or not an average score is considered to be a passing grade depends upon which specific questions are missed; for example, being able to recognize the ECG pattern of ventricular fibrillation is critical to know in any unit. Since the BKAT is being used in a wide variety of clinical settings, which specific questions are essential to know for that setting is decided by the nurse administering the BKAT-8S R.

Requests for Copies of the BKAT-8S R

The BKAT-8S R is being provided at cost to nurses who work in critical care as a service to nursing and to the ministry that nursing represents. A payment of $15.00 is requested to cover photocopying, postage, handing, and continued validity and reliability testing. Permission to use the BKAT-8S R and to photocopy it can be obtained by writing to Jean C Toth, RN, MSN, PhD; P O Box 6295, Washington DC, 20015 (bkat7.toth@yahoo.com , www.BKAT-toth.org)

Data Collectors for BKAT-8S R

Data collection for the BKAT-8S R include the following:

Cindy Craven, RN, BSN, North Carolina

Shannon Davis, RN, BS, MSNEd, PCCN, Arizona

Susan Dirkes, RN, MS, CCRN, Michigan

Karen Jamison, RN, FNP-C, PhD, Arizona

Donald Johnstone, RN, MBA, Massachusetts

Cara Kenny, RN, MS, Massachusetts

Kimberly Kort, RN, BSN, CCRN-CSC, Arizona

Peggy Martin, RN, BSN, Ohio

Virginia Smith, RN-BC, CCRN, CDE, New York

Authors of the BKAT

The initial version of the BKAT was coauthored by:

Jean C Toth, RN, CV-CNS, MSN, PhD, BCCC

P. O. Box 6295

Washington, DC 20015

Bkat7.toth@yahoo.com

and

Kathleen Ritchey, RN, CNS, MSN

Formerly of the Veterans Affairs Medical Center

Washington, DC 20422

Each subsequent BKAT and Versions of the BKATs were authored by Dr Jean Toth, RN, The Catholic University of America, Washington, DC 20064.